Provider Demographics
NPI:1821978164
Name:FUKADA, YUICHI (LMT)
Entity type:Individual
Prefix:MR
First Name:YUICHI
Middle Name:
Last Name:FUKADA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10559 SW TIGARD ST APT 55
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4148
Mailing Address - Country:US
Mailing Address - Phone:503-754-8902
Mailing Address - Fax:
Practice Address - Street 1:1750 SW SKYLINE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2536
Practice Address - Country:US
Practice Address - Phone:503-754-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16601225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist